What is sum assured in health insurance?

Sum assured in health insurance is the maximum amount that an insurance company will pay for medical expenses incurred during the policy period. It acts as a financial safety net, ensuring that policyholders have access to quality healthcare without worrying about the high costs associated with medical treatments.

The sum assured is typically chosen by the policyholder when they purchase the health insurance policy. It can range from a few lakhs to several crores, depending on the individual's needs and budget. Some policies also offer the option to increase the sum assured over time through top-up plans or riders.

When making a claim under a health insurance policy, the policyholder can use the sum assured to cover various medical expenses, including:

- Hospitalization expenses, such as room rent, doctor's fees, nursing charges, and diagnostic tests

- Surgical expenses, including surgeon's fees, anesthesia, and operation theatre charges

- Daycare treatments that require hospitalization for less than 24 hours

- Pre-and post-hospitalization expenses for a specified number of days

- Ambulance charges

- Medicines and consumables prescribed by a doctor

- Alternative treatments, such as Ayurveda, Unani, Siddha, and Homeopathy (subject to policy terms)

It's important to note that the sum assured does not cover all medical expenses. There may be certain exclusions, such as cosmetic surgeries, dental treatments (except for accidental injuries), and certain pre-existing conditions. Additionally, some policies may have sub-limits for specific treatments or procedures.

Policyholders should carefully review the policy document to understand the sum assured, coverage details, exclusions, and terms and conditions before purchasing a health insurance plan.